Greyt Matters

Sarge had another round of Vincristine today.  He is doing great!

Daphne, on the other hand, is having a bad day.  😦  In the middle of the night, I heard her cry out in pain and I thought she might have caught her dew claw on her bed while digging her nest.  But then this morning, she did not want to go on a walk.  We made it down the driveway and two houses away but then she refused to go any further.  It seemed like she was favoring her left front leg but it was not totally obvious. 

The other clue that we had a problem:  when Sarge and I returned from his chemo treatment, Daphne did not greet us at the door.  She just laid on her bed in the back room.  😦

Not interested in going for a walk.  Not excited to see Sarge and me when we came home.  I knew something was definitely wrong.

Luckily, my regular vet was able to work her in late in the day.  He examined her and he thinks she may have possibly sprained her back somehow.  He could tell that she is definitely in pain but the source/cause of the pain is unclear.  He gave me some big ol’ pain meds to give her daily for at least the next four days so we can see if that helps.  I am to get back to him if she starts to limp worse, vomit, have problems with BMs, etc. 

I told him that I was paranoid about bone cancer now that I have seen so many of the greyhounds diagnosed with it on the Circle of Grey Yahoo group.  He said that he could not know for sure, but he did not think that was the problem. 

I hope those pain meds do the trick and she is back to normal quickly!

P.S.  Here are some great pictures of greyhounds having a blast in the snow: http://www.beevalegreyhounds.com/gallery/taunoverakahjot/

Okay, I got behind because of the holidays…this post should have been published on December 22nd, the Wednesday before Christmas.

Sarge had another round of Cytoxan on the 22nd.  He had no issues with the treatment, and he has been doing great for the past two weeks.  His fur has also started growing again, and it has filled up the bald patch where he had his bone marrow sample back in September.  He is also shedding like crazy because I think the new fur is pushing out the old.

The other thing to report around this time period is that I ran into a friend who told me that her beagle, Vanessa, had lymphoma last year, and she took her to Dr. Hamilton for chemo treatments.  The bad news is that Vanessa died after the 14th treatment because she relapsed during the bi-weekly portion of the protocol.   I don’t know this for sure, but I am trying to tell myself that she probably had the Type T (tougher) lymphoma whereas Sarge has the Type B (better). 

I’m just lovin’ every moment I have with him and trying (with mixed success) to not think about bad things that could happen in the future.

Vincristine today…not much to say…all is well so far!

Super Sarge

On Wednesday, Sarge had his eighth chemo treatment, which means we are half way done!  And…we move to an every-other-week schedule.  Woo hoo!

Instead of the Adriamycin, he ended up getting Epirubicin, which the discharge instructions calls  “an analog of Adriamycin that has similar effectiveness.”  Adriamycin is on national backorder.

I had mixed feelings about this turn of events.   On the one hand, I was glad that Sarge was not going to have to deal with the “cumulative cardiac toxicity” of Adriamycin, but on the other hand, I don’t know how he is going to react to this new drug, Epirubicin.

But, so far, so good.  Today is Friday, and Sarge has been doing really well.  He was not interested in his Kong yesterday afternoon, so his appetite might be a little affected, but he has been eating other stuff, e.g., a Hebrew National hot dog and chicken, to make up for it and also going on really long walks.  🙂

I am extra nervous about dealing with adverse side effects this time because my car is out of commission.  😦  While driving home from Sarge’s chemo treatment, the check engine light came on and the car would not accelerate above 30 mph or so.  Luckily I was almost home when it happened, and I was able to get off the interstate and limp home.  I called a neighbor and she graciously agreed to be on call in case Sarge needs to make a run to the animal hospital.

But, hopefully, that will not be required.

Me and My Pack

I hope everyone had a great Thanksgiving yesterday.  I did, and I am especially grateful that my is boy is doing well!

Another round of Vincristine for Sarge today.  (Of the seven treatments so far, four have been Vincristine…seemingly the most benign of the 3 drugs).

He has been snoozing most of the day, although we did take a long walk mid-afternoon and he enjoyed a frozen Kong afterwards.

I was afraid his white blood count would be down this morning because of last week’s Cytoxan, but apparently all was well.  I will be checking his temperature in the coming days though to make sure there is no return trip to the hospital.

The only other new development is that he may not be getting the scary Adriamycin next week.  The vet tech said both the Adriamycin and its generic are on back-order nationwide (affecting humans and hounds in chemo).  She said Sarge would get a dose of Epirubicin if the Adriamycin is not available.  She said this drug is like Adriamycin but it is not toxic to the heart but there is a slightly greater chance of G-I issues.  I will, of course, be Googling Epirubicin this weekend so I can torture myself some more as I learn of the nasty side effects that are possible.  :-0

I questioned the vet tech about the cumulative cardiac toxicity of the Adriamycin this morning.  She claims that it is not a big deal for dogs since they are getting a much smaller dose than humans (unless the dog comes into chemo with heart problems).  But I would prefer to get my information from someone who went to vet school.  Unfortunately, he is more elusive than the vet techs.

The good news is that we are almost half way done with these scary chemo treatments!!!

Sarge got the dreaded Cytoxan yesterday.  This drug is given in pill form, and the oncologist did reduce his dosage from 5 pills to 4 (50 mg each) given Sarge’s bad reaction the last time he had it.

So far, Sarge has been doing fine…a little low energy yesterday and today.  Hopefully, he will bounce back by this weekend.  And, God help us, please no fever (for which we need to be on the lookout for the next 7 – 10 days).

I’m definitely struggling with whether I am doing the right thing or not.  While Sarge is eating enthusiastically, going on long walks, and seemingly not in pain, he just seems to have lost his spark.  The personality I fell in love with has been diminished.  I miss the kisses, the smiles, the purring during a belly rub…

Plus, I am really starting to freak out about the cardiac toxicity side effects of the Adriamycin, which he is scheduled to receive for a second time on the day before Thanksgiving.

My regular vet gave me a document to read concerning evaluating a dog’s quality of life.  I am going to spend time with that this weekend.  I think it will help for me to learn how you can more objectively evaluate this very, very emotional process of dealing with end of life issues.

Sarge is scheduled for his second dose of Cytoxan tomorrow, assuming his white blood count is above the minimum number.  That would be the Cytoxan that ultimately put him in the hospital the last time because it hit his white blood count hard, and he ended up with a bacterial infection and a raging fever.  Waaaa!  😦

Plus, I just made the mistake of reading another blog about canine lymphoma where the writer posted an official looking description of the side effects of adriamycin, which Sarge has had one time…side effects that include cardiac toxicity.  I had seen mention of this particular adverse effect in a document my vet had given me for another purpose, and it called the cardiac toxicity a “cumulative problem…typically arising after six doses.”  Sarge is supposed to have four.

Chemo is really a scary thing.

As of this morning, Sarge has made it through five rounds of chemo.  🙂  Eleven more treatments to go.  :-0

Of course, I had to talk to the oncologist before they went ahead and did anything beyond checking his blood counts.  My regular vet, Dr. Fowler, had given me the results of Sarge’s Friday CBC, and he was starting to get concerned about Sarge’s ability to fight off infections.  He was more concerned about the number of neutrophils in his blood and not so concerned about the WBC number.

But Sarge showed no signs of fever over the weekend or on Monday or Tuesday, and when we went in this morning, no fever either.  The oncologist said Sarge’s blood counts were better than the Friday counts, and he was not concerned about white count, red count, or neutrophils.  Overall, he thought Sarge was in fine shape.

When I brought up Sarge’s loss of energy, i.e, that he was wiped out for a good solid week after the last treatment, he said that Adriamycin was the one that typically hits them the hardest.  He was not concerned by Sarge’s loss of energy since the main concerns with this drug are vomiting, diarrhea, and loss of appetite, and Sarge had only a minor problem with his appetite, which we were able to overcome.

I stressed that, while Sarge’s overall energy level has come back pretty well over the past few days, he still seems to have lost his spark.  His joy of life seems diminished; that means, no kisses, no smiles, and no purring when his belly is rubbed.  Which seems to indicate that he does not feel well on some level or maybe he is depressed.  I know it has been depressing me.  😦

Pensive Sarge

The oncologist just said that he has no clinical reason why Sarge would be “withdrawing.”  He thinks Sarge should be acting fine.  He seemed a bit dismissive of my concerns, but that may just be his unintended body language.  We chatted a little while longer about where Sarge is at, and then he went back to the lab and gave Sarge his injection, and I sat in the waiting room slightly annoyed by the conversation.

The good news is that today’s Vincristine injection seems to have perked Sarge up a bit.  🙂  Several times he did the play barking and spinning around thing that he likes to do.  I also got a couple of little kisses, which made me feel better.

Sarge is an important component of my anti-depressant therapy.  If he ain’t happy, then I ain’t happy.  Maybe he is getting a little happier.

And not to be missed, Daphne had a birthday yesterday.

She Wore a Rasberry Beret

My little princess is now 10 years old.

I think I am being tested.

Tuesday we made an unexpected run to my regular vet when Daphne got stung by a bee or wasp or something.  We were out for our regular mid-afternoon walk when, all of a sudden, she went lame in her left front leg.  My initial thought was: bone cancer!  (Can you say paranoid?)  But then she started gnawing on her foot and biting her upper leg and then she had what seemed to be a seizure.  Only after much coaxing did we make it home because she did not want to walk on that one leg.

I called my vet and they were able to see us right away.  Fast forwarding to the end of this episode…Daphne got a shot of Benadryl and she has been fine since then.  Sheesh!  Just what I needed: another canine crisis!

In the meantime…I had already scheduled an appointment for Sarge to see my regular vet on Wednesday to have his blood counts checked because he has been acting like an old dog since this past Friday or Saturday.  I was afraid his white blood count may be low again, and I also thought it would be a good time to check in with my regular vet now that we have finished one cycle of the chemo drugs.

So Sarge went in a day early courtesy of Daphne and the bee.

I had a good long talk with my vet about cancer, chemo, and expectations. He thinks we just need to suck it up for the next 6 months or so during the chemo treatments.  Sarge may not be himself during this time, but he thinks I will get my (I don’t want to say “old”) original dog back after we have finished these 16 rounds of chemo.  He reiterated that he thought lymphoma was definitely a cancer worth fighting in a dog.

After reviewing the lab results, my vet was not concerned with Sarge’s white blood count, but he thought his red blood count was low.  The HCT value was 41.1, which is within the normal range of 37 – 55% for a typical dog.  But greyhound values are normally much higher (which is why they are desirable as canine blood donors).  I looked it up online, and I saw two HCT ranges that are supposed to be normal for greyhounds: one said 55 – 65 and the other said 45 – 65.  Using either scale, Sarge was below normal at 41, which would make him anemic…which might explain why he has been so sluggish of late.

So, on Thursday, my vet consulted with the oncologist about the HCT values.  But the oncologist said he was not overly concerned about the HCT number because he said Sarge has been in the low 40s since the treatments started.  He just wants to monitor the situation to make sure it does not get worse.

In other words, he wants to stay the course.  But I would rather not wait until there is a crisis to do something about his low red blood count.

Just like the human healthcare system, you have to be your own advocate or case worker to make sure you are getting optimal care.  Overall I think the oncologist is doing a good job, but that hospital is a machine that processes high volumes of animals.  Sarge needs me to start paying more attention to the details.

Which is why I will be getting copies of his blood work from now on, and I will be monitoring the details to make sure this HCT value does not get critically low.  When Sarge checked into the hospital on October 8th, his HCT was 45.1.  Twenty days later, it was 41.1.  Maybe it has been up and down over the past few weeks, but with only these two points of data, it appears to be a significant downward trend to me.

My regular vet is – for the most part – deferring to the oncologist.  But he did suggest that we do another blood count today to see if there have been any changes in the past 3 days.  If the numbers are lower, then he will contact the oncologist again and express his concerns more strongly.

After checking the files, my vet found that Sarge’s HCT value was 60% when he did a blood count back in 2007.  Hmmm….

I don’t know if the red blood count is being hit by the chemo or the cancer or both.  Sarge was diagnosed with slight level of lymphoma in his bone marrow, which is where the red blood cells are produced.

I plan to add some liver and leafy greens to Sarge’s diet.  My vet also said I could give Sarge a multi-vitamin from PetSmart.  I feel the need to do something.

Tomorrow or Monday we will get the results from today’s blood count.

Next Wednesday is another chemo day.

Sarge has always been a big kisser.  It’s one of his ways of expressing happiness and affection.  I realized tonight that I haven’t gotten a kiss from Sarge for awhile.  😦

Overall, he seems to be doing well now.  We had a little rough patch starting about 36 hours after the Adriamycin treatment when his appetite took a hit.  (BTW – that’s what they mean by anorexia in dogs, i.e., loss of appetite not a body image problem!)

So Sarge started to experience some anorexia Thursday night and into Friday.  I stopped at the grocery store Friday afternoon and loaded up on the protein: 3 packs of chicken, a rotisserie chicken, a pack of hot dogs, a pack of tuna, eggs, and even some baby food.  When I walked in the house with that load of groceries, Sarge and Daphne were literally dancing around the floor in anticipation of rotisserie chicken.

Using the chicken and tuna, we’ve gotten through the weekend with full tummies.  And we’ve gone on several long walks.  But I can tell that Sarge is definitely not his old self because he no longer does his nightly spinning around in circles and I no longer get my kisses.

I hope this is temporary.